Background and Objective: Cognitive reserve (CR) mediates the clinical expression of brain pathology in Alzheimer’s disease, while there are much less relevant data in frontotemporal dementia (FTD). In the present study we examined whether CR, measured using the Cognitive Reserve Index (CRI), correlated with regional cerebral blood flow (rCBF) in Greek FTD patients. Methods: Eighty FTD patients, i.e., 47 with behavioral variant FTD (bvFTD) and 33 with primary progressive aphasia (PPA), were enrolled into this study. CR was assessed using the CRI questionnaire, which provides a total score (CRI) and 3 subscores, i.e., CRI-education, CRI-working activity, and CRI-leisure time. The FTD-Clinical Dementia Rating Scale was used to assess the severity of dementia and a brain SPECT study was performed to measure rCBF. Finally, multiple regression analyses were conducted to explore correlations between CR indices and frontotemporal rCBF. Results: In both the bvFTD and the PPA groups, higher scores in the CRI, CRI-education, and CRI-leisure time correlated with lower rCBF in the bilateral frontal and left temporal cortex, respectively, controlling for age, sex, time since symptom onset, and disease severity. Conclusion: In the present study, lifetime participation in leisure time activities was found to mitigate the burden of disease in bvFTD and PPA patients. Moreover, FTD patients with a higher educational attainment were able to cope better with greater brain damage. Determination of the most suitable activities to build an adequate level of CR is crucial for dementia prevention.
Cognitive reserve (CR) is thought to reflect the cumulative brain potential derived from various cognitively demanding activities throughout the entire life. It seems to mediate both one's cognitive performance and clinical expression of different brain pathologies, such as Alzheimer's disease. Many researchers have tried to assess CR by using proxies, such as educational and occupational level, participation in leisure time activities and intelligence, alone or in various combinations. Recently, a new tool for measuring CR status was constructed, the Cognitive Reserve Index questionnaire (CRIq), comprising of all known CR proxies. CRIq also takes into account the amount of time spent during each of these activities, thus capturing the core idea behind CR theory: its active day to day formulation during all age stages. Aim of the present study was to adapt CRIq for the Greek population. The questionnaire was administered to 591 participants (age range 18-89) stratified in three age groups (young adults, middle-aged, elderly). The middle-aged group showed higher total CRI as well as CRI-Education, CRI-WorkingActivity and CRI-LeisureTime scores compared to both other groups, reflecting more years of engagement in all activities. Gender also influenced CRI scores, with men scoring higher than women, again resulting from historical and social perspectives. Overall, the CRIq showed satisfactory internal consistency, was easy to administer and its adaptation process provided solid and interpretable results. The Greek version of CRIq enriches existing dementia research methodology and allows for valid results in an ever growing field.
Early onset dementia (EOD) is a major diagnostic challenge as it often presents with atypical features and may be attributed to treatable diseases. Primary degenerative dementias (Alzheimer's disease-AD, frontotemporal lobar degeneration-FTLD, Lewy body dementia-LBD), although traditionally considered to affect older people, are still a main cause of EOD. 491 demented patients were assessed from January 1, 2003 to December 31, 2010 in the Neurology Department of a tertiary referral center. Patients were classified as AD, behavioral variant frontotemporal dementia (bvFTD), non-fluent agrammatic variant primary progressive aphasia (naPPA), semantic variant PPA (svPPA), corticobasal degeneration (CBD), or progressive supranuclear palsy (PSP) who also met criteria for naPPA and LBD. Finally, their demographic characteristics were analysed, according to age at onset (EOD <65 years, late onset dementia-LOD ≥65 years). From the 491 patients, 137 (27.9 %) were EOD. In the EOD group, 52 (38 %) were diagnosed with bvFTD, 34 (24.8 %) with AD, 27 (19.7 %) with naPPA, 10 (7.2 %) with svPPA, 12 (8.8 %) with CBD or PSP, and 2 (1.5 %) with LBD. Demographic characteristics did not differ significantly among diagnostic categories in the EOD group, while in the LOD group FTLD patients were younger and more frequently men compared to both AD and LBD patients. EOD patients had more years of education than LOD patients. Degenerative disorders as causes of EOD are not rare. High clinical alertness is warranted to achieve correct and timely diagnosis.
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